In response to RFA-AI-16-031 we propose Keeping it LITE: Exploring HIV Risk in Vulnerable Youth with Limited Interaction which will use electronic recruitment to engage young MSM and TGW in an innovative cohort designed to monitor HIV risk and prevention behaviors and attitudes with minimal engagement. This low-intensity strategy will allow us to describe ongoing infection trends across the Chicago area and characterize individual and community level factors that enhance HIV risk. Further, we will use our large, longitudinal cohort of HIV-uninfected youth to identify barriers to PrEP access, uptake and adherence among the very young and monitor changes as PrEP technologies advance. More intensive study of those who acquire HIV, using innovative social network and phylodynamic analysis, will identify clusters of ongoing active transmission and test the feasibility of novel approaches to target biomedical prevention to those in the highest risk subgroups. As the longitudinal data accumulate, we will test virtual strategies for optimal HIV prevention for youth. We have engaged academic and public health partners, community opinion leaders and affected young MSM and TGW to assure our approach has the greatest likelihood of leading to meaningful advances in HIV prevention as well as tools and strategies that are easily implemented and scalable for export to other communities suffering from similar epidemics of HIV infection. This will be accomplished with the following specific Aims: Aim 1: Enroll and retain a large cohort of 13-34 year old MSM and TGW at high risk of HIV acquisition. We will employ tested and novel enrollment strategies using social media and targeted electronic advertisement to cost-effectively enroll at least 1000 MSM and TGW/year in order to capture at least 210 seroconversions to characterize those behaviors, venues and sociodemographic characteristics which predict HIV acquisition. Aim 2: Characterize real-world PrEP use among young MSM and TGW. Articulate individual, provider and community level predictors of PrEP uptake, PrEP adherence and PrEP discontinuation. We hypothesize that adolescent and very young MSM/TGW have unique barriers to PrEP uptake and adherence which reflect their developmental stage as well as external factors such as stigma and lack of resources. Aim 3: Use social network and phylodynamic analysis to characterize seroconverters. We hypothesize that careful evaluation of the characteristics of ongoing transmission networks will provide data for optimal design and targeting of enhanced partner services and established and novel biomedical prevention strategies. Aim 4: Characterize the HIV care cascade among newly infected young MSM and TGW. Identify individual, network, community and structural predictors of eventual viral suppression and pilot developmentally appropriate interventions to optimize HIV and treatment as prevention outcomes. Aim 5: Use the longitudinal data from Aims 1-4 to design and test virtual interventions for innovative partner services and optimization of the PrEP and care cascades among adolescent and young MSM/TGW.
|Effective start/end date||9/1/17 → 6/30/19|
- Hektoen Institute for Medical Research (50042-324-NWU01//1UG3AI133676-02)
- National Institute of Allergy and Infectious Diseases (50042-324-NWU01//1UG3AI133676-02)